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2. 
4. Water Adjustment Form
6. Name:
7. Account Number:
9. Address:
11. Phone Number:
12. E-Mail Address:
14. Date the leak was detected:
15. How long was the water leaking?
17. Who repaired the leak?
18. Please give a brief explanation of the leak and the way in which it was repaired.
20. Please submit a copy of the plumber's invoice or a copy of the receipts for the materials purchased for the repairs by email, fax, drop box, in office or mail.
22. Please read carefully the following information:
24. • The City may adjust charges for water use over the customer’s previous six months’ average billings for water, excluding the month of excessive consumption for which the adjustment is requested, down to our lowest water rate per 1000 gallons. This adjustment will help with the excess cost, not eliminate it. This means the adjustment could potentially leave a balance higher than a customer’s average bill.
26. * Leak adjustments are only done once per year.
28. * For sewer service, we will not adjust the customers account unless the water loss occurred during the months of December, January or February.
30. * The City is not required to offer water adjustments but does so to encourage customers to make prompt and permanent repairs for the conservation of our water resources.
32. * Account balances are always due on the 15th. Submitting this form does not prevent fees or disconnection for nonpayment.
34. By signing below, you acknowledge to have understood the information contained in this application and agree to the terms set forth.
36. Signature
37. Date:
41. Phone: 972-771-4601 Opt: 2

42. E-Mail: [email protected]

43. Fax: 972-722-8266
Leave This Blank:


45. 1. Receive an email copy of this form.
46. Email address

    This field is not part of the form submission.

47. Submit

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